Provider Demographics
NPI:1558118224
Name:100 CHIRO STAPLES CARTERSVILLE PC
Entity type:Organization
Organization Name:100 CHIRO STAPLES CARTERSVILLE PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:NICO
Authorized Official - Middle Name:
Authorized Official - Last Name:STAPLES
Authorized Official - Suffix:
Authorized Official - Credentials:DC
Authorized Official - Phone:708-712-4973
Mailing Address - Street 1:11 CHARLEY HARPER DR SE STE 140
Mailing Address - Street 2:
Mailing Address - City:CARTERSVILLE
Mailing Address - State:GA
Mailing Address - Zip Code:30120-1124
Mailing Address - Country:US
Mailing Address - Phone:678-719-0891
Mailing Address - Fax:
Practice Address - Street 1:11 CHARLEY HARPER DR SE STE 140
Practice Address - Street 2:
Practice Address - City:CARTERSVILLE
Practice Address - State:GA
Practice Address - Zip Code:30120-1124
Practice Address - Country:US
Practice Address - Phone:678-719-0891
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2024-05-01
Last Update Date:2024-05-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Single Specialty